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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> am performing wofR on a prooerty I own er occupy. <br />I nm ~ registered builder OR ( ) the authorized reeresentatwe <br />Of a registered Du der <br /> <br />SIGNATURE OF APPLI~N¥: ................ <br /> DATE', ................. <br /> <br />AUMBVILLE <br /> <br />~ffds'~ ~b'~'~: - - ; <br /> <br /> 97325 <br /> <br /> PHON2t 7~9-2~77 ; VALUATION: <br /> <br /> . ~ ~ / ~ ---~ b ....... ~ ....... <br />~6~h~ ; ' ~ ~ ~ ' ' ' .............. "* <br /> <br />W~'TER SUPPLY" <br />TEST HOLEg <br /> <br />EXI~TZN~ TANK SZZ~ <br />EXISTING DR~%N F%ELD <br />SEPTIC,TAN~ PUMPED; <br />PREVI'OUS'"NO; <br /> <br /> ITEM QUANTITY AHO,, hi, <br />SITE -;VALUA r:l:ON, EA. AD'DL." LOT' : i ~.,.,,~. <br /> <br /> . .' ..".~nZD...... REOE~r~... ." . <br /> · · · .. ':.. '" , ,"~,~ACE' Yd~ ~, ~'~ <br /> <br />F~YF, F.. BAKF3~ CHUCK .,, '..',,,, ; RECEIPT ND~ 6~4~4 <br />R,._I.,E~V..D BY. ~ ~; ,, ,~,~,.~ ...... ~ .~_,.. . TYPE. CE ~HECK ,~. <br /> <br /> ,- --> -- <br /> <br />;,Jf)l"~: ~HfS ~E8 HOT ~ANT ~R '~MP[Y PE~.M.IS~ION TO ~UILD'ON THI~ PARCEL. <br /> <br />' ..... ...... * -' · <br /> <br />FORM # MC 1 ~,~, gEV. ~ OFF[CE COPY <br /> <br /> <br />